Bosomprah Samuel, Aryeetey Genevieve Cecelia, Nonvignon Justice, Adanu Richard M
Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana.
Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana.
BMC Pregnancy Childbirth. 2014 Dec 24;14:415. doi: 10.1186/s12884-014-0415-x.
The single most critical intervention to improve maternal and neonatal survival is to ensure that a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of an emergency. This study aims to describe changes in percentage of skilled birth attendants in Ghana and to identify causes of the observed changes as well as the contribution of different categories of mother's characteristics to these changes.
This study uses two successive nationally representative household surveys: the 2003 and 2008 Ghana Demographic and Health Surveys (GDHS). The two datasets have comparable information on household characteristics and skilled attendants at birth at the time of the survey. The 2003 GDHS database includes information on 6,251 households and 3639 live births in the five years preceding the survey, whereas the 2008 GDHS database had information on11, 778 households and 2909 live births in the five years preceding the survey. A decomposition approach was used to explain the observed change in percentage of skilled birth attendants. Random-effects generalized least square regression was used to explore the effect of changes in population structure in respect of the mother's characteristics on percentage of skilled birth attendants over the period.
Overall, the data showed absolute gain in the proportion of births attended by a health professional from 47.1% in 2003 to 58.7% in 2008, which represents 21.9% of gap closed to reach universal coverage. The increase in skilled birth attendants was found to be caused by changes in general health behaviour. The gain is regardless of the mother's characteristics. The structural change in the proportion of births in respect of birth order and mother's education had little effect on the change in percentage of skilled birth attendants.
Improvement in general health behaviour can potentially contribute to an accelerated increase in proportion of births attended by skilled personnel in Ghana.
改善孕产妇和新生儿存活率的最关键干预措施是确保每次分娩时有具备助产技能的合格卫生工作者在场，并且在紧急情况下有交通工具将产妇转运至提供产科护理的转诊机构。本研究旨在描述加纳熟练接生员比例的变化情况，确定观察到的变化的原因以及不同类别母亲特征对这些变化的影响。
本研究使用了两次连续的具有全国代表性的家庭调查：2003年和2008年加纳人口与健康调查（GDHS）。这两个数据集在调查时具有关于家庭特征和出生时熟练接生员的可比信息。2003年GDHS数据库包含调查前五年中6251个家庭和3639例活产的信息，而2008年GDHS数据库包含调查前五年中11778个家庭和2909例活产的信息。采用分解方法来解释观察到的熟练接生员比例的变化。使用随机效应广义最小二乘回归来探讨母亲特征方面的人口结构变化对该时期熟练接生员比例的影响。
总体而言，数据显示由卫生专业人员接生的比例从2003年的47.1%绝对增加到2008年的58.7%，这意味着在实现普遍覆盖方面缩小了21.9%的差距。发现熟练接生员比例的增加是由一般健康行为的变化引起的。这种增加与母亲的特征无关。出生顺序和母亲教育程度方面的出生比例结构变化对熟练接生员比例的变化影响不大。
一般健康行为的改善可能有助于加纳熟练人员接生比例的加速增长。
